Use of the Guide to Physical Therapist Practice by ...
Use of the Guide to Physical Therapist Practice by Pediatric Physical Therapists
A survey to pediatric physical therapists
who are members of the American Physical Therapy Association
Introduction
You have been selected to participate in this survey because you are a member of the American Physical Therapy Association, Section on Pediatrics or have indicated that one of your practice specialties is pediatrics. The purpose of this survey is to gather information on how pediatric physical therapists utilize the Guide to Physical Therapist Practice (Guide), Edition 2. Throughout the survey there are definitions from the Guide, please answer the questions in relation to these definitions. This is your opportunity to share how you use the Guide in your practice.
The APTA plans to revise the Guide beginning in 2008. The third edition will be published in approximately 2010. Taking this survey is your opportunity to share information about how you, as a pediatric physical therapist, are using the Guide. This survey is being conducted in partial fulfillment of requirements for a DScPT degree at the University of Maryland, School of Medicine, Department of Physical Therapy and Rehabilitation Science. This survey has been approved by the Institutional Review Board of the University of Maryland.
It should take approximately 20 minutes to complete this survey. There is no penalty if you do not choose to participate in the survey. Please follow the on screen directions for completing the survey. Feel free to consult your copy of the Guide as you take the survey. Let us know if you have any questions or comments about the survey!
Thank you.
Sheree Chapman York, PT,MS,PCS
President, Section on Pediatrics
American Physical Therapy Association
Connie Johnson, PT, MS Leslie Glickman, PT, PhD
Investigator Primary Investigator
Student, DScPT Director, Post-Professional Programs
University of Maryland Department of Physical Therapy and Rehabilitation Sciences
14516 South Hills Court 100 Penn St. Room 205A
Centreville, VA 20120 Baltimore, MD 21201
(703) 830-6354 (410)706-4543
Cjohn012@umaryland.edu lglickman@som.umaryland.edu
Note: If the respondent exits the survey, the final screen will read: Thank you for participating in the survey Use of the Guide to Physical Therapist Practice by Pediatric Physical Therapists. Your input is greatly appreciated!
Demographic Information
1. Please indicate your sex:
o Female
o Male
2. Please indicate your age in years at your last birthday:
_____years
3. Which one of the following best describes your race or ethnic origin?
o American Indian or Alaskan Native
o Asian
o African American or Black (Not of Hispanic Origin)
o White (not of Hispanic Origin)
o Hispanic/Latino
o Pacific Islander or Native Hawaiian
o Other
4. Please indicate the zip code (5 digit) in which you currently reside.
________
5. How many years have you been a physical therapist?
(Please indicate 0 if less than one year.)
_____years
6. How many years have you been a pediatric physical therapist?
(Please indicate 0 if less than one ear)
_____years
7. Considering all your years as a physical therapist, how many years have you provided any direct patient care? You should include any years in which you provided care in addition to your primary position, e.g., involvement in a practice plan while you were a full-time faculty member. (Please indicate 0 if less than one year.)
_____years
8. What is the highest earned degree (or degrees) you hold in any area of study? (Select only one.)
Baccalaureate degree
Master's degree
PhD (or equivalent, e.g. EdD or ScD)
DPT
tDPT
PhD (or equivalent) and DPT
PhD (or equivalent) and tDPT
Other, please specify:___________________
9. What was your first (entry-level) physical therapy degree, prior to taking the licensure exam?
o Baccalaureate degree
o Post baccalaureate certificate
o Master's degree
o DPT
o Other, please specify_________________
10. Are you currently enrolled in a post-professional graduate program or taking courses for academic credit to meet the requirements for a post-professional degree in any discipline?
o Yes, research doctorate
o Yes, clinical doctorate
o Yes, Master's
o No
11. Are you an ABPTS certified clinical specialist?
o Yes
o No, but I plan to be certified at some time
o No, it is not in my plans for professional development
12. Please indicate any additional professional certifications you possess. (If none, leave blank.) _____________
13. Using a total of 35 or more hours per week (at your primary position) as the definition of ‘full-time’, which one of the following describes your current employment status?
o Full-time salaried
o Part-time salaried
o Full-time self employed
o Part-time self employed
o Full-time hourly
o Part-time hourly
o Retired (Thank you. Please skip to the end for instructions on submitting the survey.)
o Unemployed/not seeking work (Thank you. Please skip to the end for instructions on submitting the survey.)
o Unemployed/seeking full-time employment (Thank you. Please skip to the end for instructions on submitting the survey.)
o Unemployed/seeking part-time employment (Thank you. Please skip to the end for instructions on submitting the survey.)
14. Please indicate the zip code (5 digit) in which you currently do all or most of your work.
_________
15. Which of the following best describes the type of facility or institution in which you currently do all or most of your work (your primary position)?
o Acute care hospital
o Subacute rehab hospital (inpatient)
o Health system or hospital-based outpatient facility or clinic
o Private outpatient office or group practice
o SNF/ECF/ICF
o Patient’s home/home care
o Early intervention
o School system (preschool/primary/secondary)
o Academic institution (post-secondary)
o Health and wellness facility
o Research center
o Industry
o Other (please specify)
If you selected other, please specify:__________
Use of the Guide to Physical Therapist Practice by Pediatric Physical Therapists
A survey to pediatric physical therapists
who are members of the American Physical Therapy Association
Patient/Client Management
The Guide contains five elements of patient/client management: examination, evaluation, diagnosis, prognosis, and intervention. We are going to consider each one separately.
(next page)
Examination and Evaluation
The Guide defines examination as “the process of obtaining a history, performing a systems review, and selecting and administering tests and measures to gather data about the patient…initial examination is a comprehensive screening and specific testing process that leads to a diagnostic classification. The examination process also may identify possible problems that require consultation with or referral to another provider.”
Evaluation is defined as a “dynamic process in which the physical therapist makes clinical judgments based on data gathered during the examination. This process also may identify possible problems that require consultation with or referral to another provider”. Evaluation includes synthesis of clinical findings.
16. When performing an examination, do you routinely do the following?
Perform a history ____ yes _____no
Perform systems review ____ yes _____no
Select tests and measures ____ yes _____no
17. Which of the following systems do you routinely review? Check as many as apply:
_______ Cardiovascular/pulmonary (heart rate, respiratory rate, blood pressure, edema)
_______ Integumentary (skin integrity, skin color, presence of scar formation)
_______ Musculoskeletal (symmetry, range of motion, strength, height, weight)
_______ Neuromuscular (balance, locomotion, transfers, and transitions)
_______ Communication, affect, cognition, learning style (communication ability, affect, cognition, language, learning style, the assessment of the ability to make known; consciousness; orientation; expected emotional/behavioral responses; and learning preferences)
18. Please complete the items that pertain to how you perform and document your systems review. You may check as many items as apply.
| |I review this system by: |I document results: |
| |History |Observation |Direct Measurement|Always |Only if significant |
|Do you write the practice | | | | | |
|pattern in physical therapy | | | | | |
|progress notes? | | | | | |
|Do you write the practice | | | | | |
|pattern in your summation of | | | | | |
|care (or discharge summary)? | | | | | |
|Do you ever choose more than | | | | | |
|one practice pattern? | | | | | |
20. On a scale of 1 to 5, please rate the overall usefulness of the physical therapy practice pattern in patient/client management.
| |1 |2 |3 |4 |5 |
| |Not useful | | | |Extremely Useful |
|Evaluating | | | | | |
|Determining physical therapy diagnosis| | | | | |
|Determining prognosis | | | | | |
|Selecting and providing interventions | | | | | |
20a. In each practice pattern, the Guide lists information under the heading “examination”. How would you change the physical therapy practice pattern to make it useful in examination? (check as many as apply)
______no change is necessary
______the information should be more specific.
______the information should be more generic.
______there is too much information.
______elements of my examination are not listed under “examination”.
______no change necessary
______other comments.________________
20b. Would you add, delete, or change the physical therapy practice patterns to more accurately reflect your practice? (check as many as apply)
______I would add practice patterns. (if checked go to 20c)
______I would delete practice patterns. (if checked go to 20d)
______I would change the practice patterns. (if checked go to 20e)
If 20b is checked, the following question will be generated:
20c. What specific practice pattern would you add?________________
20d. What specific practice pattern would you delete?________________
20e. How would you change the practice patterns?_________________
Diagnosis
The Guide defines diagnosis as “both the process and the end result of evaluating examination data, which the physical therapist organizes into defined clusters, syndromes, or categories to help determine the prognosis (including the plan of care) and the most appropriate intervention strategies...The assigning of a diagnostic label through the classification of a patient/client within a specific practice pattern is a decision reached as a result of a systematic process. This process includes integrating and evaluating the data that are obtained during the examination to describe the patient/client condition in terms that will guide the physical therapist in determining the prognosis, plan of care, and intervention strategies. Thus the diagnostic label indicates the primary dysfunctions toward which the physical therapist directs interventions.
21. I determine a physical therapy diagnosis:
|1 |2 |3 |4 |5 |
|Never | | | |Always |
| | | | | |
22. Do you feel it is necessary for a physical therapist to make a diagnosis?
|1 |2 |3 |4 |5 |
|Never | | | |Always |
| | | | | |
23. Which diagnostic labels or classifications do you use in your physical therapy practice: (check as many as apply)
___________ICD-9 code
___________physical therapy practice pattern
___________medical diagnosis
___________diagnosis of impairments
___________diagnosis of functional limitations
___________other classification terminology that relates to diagnosis
___________other___________
23a. In each practice pattern, the Guide lists information under the heading “diagnosis”.
In each practice pattern, the Guide lists information under the heading “diagnosis”. How would you change the physical therapy practice pattern to make this information more useful? (check as many as apply)
______no change is necessary
______the information should be more specific. If checked go to 23b
______the information should be more generic. If checked go to 23c
______the information listed under diagnosis is not consistent with my practice. If checked go to 23d.
If 23a is checked go to:
23b. How would you make the diagnosis information more specific?___________
23c. How would you make the diagnosis information more generic?___________
23d. How do you define and use diagnosis and in your practice? _____________
Prognosis
The Guide defines prognosis as the “determination of the level of optimal improvement that may be attained through intervention and the amount of time required to reach that level. The plan of care specifies the interventions to be used and their timing and frequency.”
24. Do you determine the optimal level of improvement in function when you consider a child’s prognosis?
|1 |2 |3 |4 |5 |
|Never | |Sometimes | |Always |
| | | | | |
25. Please check the following items as they pertain to prognosis and plan of care:
| |1 |2 |3 |4 |5 |
| |Never | | | |Always |
|I document the prognosis. | | | | | |
|I verbally discuss plan of care with | | | | | |
|parents/caregivers. | | | | | |
|I document the plan of care. | | | | | |
|My plan of care includes goals. | | | | | |
|My plan of care includes interventions. | | | | | |
|My plan of care includes the specific frequency | | | | | |
|and duration of physical therapy intervention. | | | | | |
|My plan of care includes anticipated number of | | | | | |
|visits to achieve goals. | | | | | |
25a. In each practice pattern, the Guide lists information under the heading “prognosis”. How would you change the physical therapy practice pattern to make this information more useful? (check as many as apply)
______no change necessary
______the information should be more specific. If checked go to 25c
______the information should be more generic. If checked go to 25d
______prognosis as defined by the Guide is not consistent with my practice. If checked go to 25e.
If checked go to:
25c. How would you make the information regarding prognosis more specific?______
25d. How would you make the information more generic?_____________
25e. How do you define and utilize prognosis in your practice?_________
Intervention
The Guide defines intervention as “purposeful and skilled interaction of the physical therapist with the patient/client…using various physical therapy methods and techniques to produce changes in the condition that are consistent with the diagnosis and prognosis. The physical therapist conducts a reexamination to determine changes in patient/client status and to modify or redirect intervention. The decision to reexamine may be based on new clinical findings or on a lack of patient/client progress. The process of reexamination also may identify the need for consultation with or referral to another provider.”
26. Please indicate how often you have performed the following in the last 6 months:
| |1 |2 |3 |4 |5 |
| |Never | |Sometimes | |Always |
|Provided coordination of care | | | | | |
|Exchanged information with another | | | | | |
|professional regarding a patient/client | | | | | |
|Documented care of the client. May | | | | | |
|include progress notes, flow sheets, | | | | | |
|checklists, summations of care | | | | | |
|Provided patient/client-related | | | | | |
|instruction to patients/clients, | | | | | |
|families and caregivers verbally | | | | | |
|Provided patient/client-related | | | | | |
|instruction to patients/clients, | | | | | |
|families and caregivers in written form | | | | | |
26a. On a scale from 1-5 with 1 being Inaccurate and 5 being Accurate please rate how accurate each statement is for your practice.
| |1 |2 |3 |4 |5 |
| |Inaccurate | | | |Accurate |
|The Guide contains interventions that | | | | | |
|do not pertain to my practice. | | | | | |
|The Guide is missing interventions | | | | | |
|that I use. | | | | | |
26b. What procedural interventions do you use in your practice? (check as many as apply)
Therapeutic exercise
______aerobic capacity/endurance conditioning or reconditioning
______balance, coordination, and agility training
______Body mechanics and postural stabilization
______Flexibility exercises
______Gait and locomotion training
______Neuromotor development training
______Relaxation
______Strength,power, and endurance training for head, neck, limb, pelvic-floor, trunk
and ventilatory muscles.
Functional training in Self-Care and Home Management
______ADL training
______Barrier accommodations or modifications
______Device and equipment use and training
______Functional training programs (back schools, simulated environments and
tasks,task adaptation, travel training)
______IADL training
______Injury prevention and reduction
______Leisure and play activities and training
Manual therapy techniques
______Manual lymph drainage
______Manual traction,
______Massage,
______Mobilization (soft tissue or joint)
______Passive range of motion
Prescription, application, and, as appropriate fabrication of devices
______Adaptive devices
______Assistive devices
______Orthotic devices
______Prosthetic devices
______Protective devices
______Supportive devices
Airway clearance techniques
______Breathing strategies
______Manual/mechanical techniques (chest percussion, chest wall manipulation,
suctioning, ventilatory aids)
______Positioning ( to alter work of breathing, maximize ventilation/perfusion, postural
drainage)
Integumentary repair and protection
______Debridement-non selective
______Debridement-selective
______Dressings
______Oxygen therapy
______Topical agents
Electrotherapeutic modalities
______biofeedback
______Electrotherapeutic delivery of medication
______Electrical stimulation
Physical Agents and Mechanical modalities
______Athermal agents (pulsed electromagnetic fields)
______Cryotherapy
______Hydrotherapy
______Light agents
______Sound agents
______Thermotherapy
______Compression therapy
______Gravity-assisted compression device (standing frame/tilt table)
______Mechanical motion device (CPM)
______Traction device
26c. What interventions would you add to the Guide (these may be procedural or others)?_____
Outcomes
The Guide defines outcomes as the “results of patient/client management, which include the impact of physical therapy interventions in the following domains: pathology/pathophysiology (disease, disorder, or condition); impairments, functional limitations, and disabilities; risk reduction/prevention; health, wellness, and fitness; societal resources; and patient/client satisfaction.”
27. In your practice, do you determine outcomes consistent with the Guide?
______yes ______no
28. In your work setting, is there a formal process for determining outcomes?
______yes ______no
The Guide states that “the physical therapist engages in outcomes data collection and analysis-that is, the systematic review of outcomes of care in relation to selected variables (eg, age, sex, diagnosis, interventions) and develops statistical reports for internal and external use.”
28a. In each practice pattern, the Guide lists information under the heading “outcomes”. How would you change the physical therapy practice pattern to make this information useful in your practice?
______no change is necessary
______the information should be more specific. If checked go to 28b
______the information should be more generic.If checked go to 28c
______outcomes, as defined by the Guide, are not consistent with my practice. If checked go to 28d
If checked go to:
28b. How would you make the information on outcomes more specific?_______
28c. How would you make the information on outcomes more generic?_______
28d. How do you define and use outcomes in your practice?______________
Those respondents who chose YES for items 27 or 28 will answer question, 28b.
28b. In what ways do you determine that outcomes have been met?
(select as many as apply)
__________documentation of attainment of therapy goals
__________analysis of on-going data collection
__________retrospective analysis of chart/documentation
__________patient satisfaction questionnaires
__________mastery of goals
__________Continuous Quality Improvement
__________reexamination of the child
__________team discussion and consensus
__________use of federally mandated outcome collection system
__________I use another type of system which is ___________________
The Disablement Framework
The Guide is based on the disablement framework as described by Nagi (Rothstein, 2001). This disablement framework includes the categories of pathology/pathophysiology, impairment, functional limitation, and disability. These terms are used to describe an individual and “to delineate the interrelationships among disease, impairments, functional limitations, and disabilities.”
The Guide defines the disablement terms as:
• pathology/pathophysiology “refers to ongoing pathological/pathophysiological state that is characterized by a cluster of signs and symptoms and (2) recognized by either the patient/client or the practitioner as ‘abnormal’.”
• impairment: are the “consequences of disease, pathological processes, or lesions…impairments occur at the tissue, organ, and system level, and they are indicated by signs and symptoms.”
• functional limitation “occur when impairments result in a restriction of the ability to perform a physical action, task, or activity in an efficient, typically expected, or competent manner.”
• Disability is the “inability or restricted ability to perform the actions, tasks, and activities related to self-care, home management, work (job/school/play), community and leisure roles in the individual’s sociocultural context and physical environment.”
29. Do you use the Nagi framework, as described in the Guide, in your clinical decision making process?
______yes ______no
If no:
29a. What framework do you use?
__________ Nagi Model
__________ International Classification of Impairments, Disabilities, and Handicaps (ICIDH)
__________ National Center for Medical Rehabilitation Research Classification
__________ International Classification of Function, Disability, and Health (ICF)
__________ I do not use a framework
__________Other (please describe) _________________________________
30. Consider the children that you work with. Do you find the Nagi disablement framework , as described in the Guide, relevant to the following elements of patient/client management?
| |1 |2 |3 |4 |5 |
| |Not relevant | |Relevant | |Extremely relevant |
|Evaluating | | | | | |
|Determining physical therapy | | | | | |
|diagnosis | | | | | |
|Determining prognosis | | | | | |
|Selecting/providing interventions| | | | | |
PART THREE OF THE GUIDE
Part Three of the Guide, on CD-ROM, is available to APTA members for $99. The CD-ROM includes lists of tests and measures used in assessment, health status, health-related quality of life, and patient/client satisfaction.
31. Do you use Part Three of the Guide? _________yes __________no
If no:
a. Have you ever seen the CD-ROM? ______yes ___________no
b. Do you have access to the CD-ROM? _______yes ___________no
c. Is the cost a reason why you have not used the CD-ROM?________yes _______no
32. Would you be more likely to use Part Three if it was available in a different format?
| |1 |2 |3 |4 |5 |
| |Not at all likely | |Somewhat likely | |Extremely likely |
33. What format for Part Three is most preferable to you? Please rank the following (“1” indicates most preferable, “2” indicates next choice, etc):
__________CD-ROM
__________web access
__________book format
__________special edition of the Physical Therapy Journal
__________other
Overall Assessment of the Guide
34. Consider the children that you work with. How useful do you find the Guide in patient/client management?
| |1 |2 |3 |4 |5 |
| |Not useful | | | |Extremely Useful |
|Evaluating | | | | | |
|Determining physical therapy | | | | | |
|diagnosis | | | | | |
|Determining prognosis | | | | | |
|Selecting/providing interventions | | | | | |
33. What do you think is the most beneficial aspect of the Guide?_________________
35. What are barriers to your use of the Guide? (check as many as apply)
_________I don’t have a copy of the Guide.
_________The Guide is too big thus not convenient to use.
_________I don’t understand how to use the Guide.
_________The Guide is missing information that is important to my practice.
_________I do not agree with the terminology of the Guide.
_________I do not agree with use of the Nagi framework.
_________I do not find the patient/client management model relevant to my practice.
_________The Guide needs to have parts expanded upon.
_________Other (please explain)_______________
36. The Guide will be revised in the next two years.
Please complete the following statements.
| |1 |2 |3 |4 |5 |
| |I strongly believe | | | |I strongly believe the |
| |the Guide should be | | | |Guide should not be |
| |changed | | | |changed |
|The examination element of the | | | | | |
|patient/client management model | | | | | |
|The evaluation element of the | | | | | |
|patient/client management model | | | | | |
|The diagnosis element of the | | | | | |
|patient/client management model | | | | | |
|The prognosis element of the | | | | | |
|patient/client management model | | | | | |
|The intervention patient/client | | | | | |
|management model | | | | | |
|The outcome component | | | | | |
|The content of the practice | | | | | |
|patterns | | | | | |
37. How would you change the framework to better reflect your practice?
______adopt a different framework.
______do not base the Guide on a framework
______have the option to choose a framework that is reflective of the situation.
______other
38. Please answer the following questions:
| |1 | |3 | |5 |
| |Rarely | |Sometimes | |Often |
|Do you consult the | | | | | |
|Guide when confronted| | | | | |
|with a new or unusual| | | | | |
|situation? | | | | | |
39. How do you use the Guide: (Select as many as apply)
______as a resource
______as a reference to answer a question
______to aid in decision making
______to justify my treatment plan to insurance companies
______other
40. Overall, how useful do you find the Guide for your practice?
|Not useful | |Useful | |Extremely useful |
| | | | | |
41. Please share any other comments you would like about the use of the Guide and its relevance to your practice.
______________________________________________________________________
Thank you for participating in the survey Use of the Guide to Physical Therapist Practice by Pediatric Physical Therapists.
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